Provider Demographics
NPI:1518443753
Name:REILLY-NILSEN, EILEEN (RN)
Entity Type:Individual
Prefix:
First Name:EILEEN
Middle Name:
Last Name:REILLY-NILSEN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1845 E 34TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-4429
Mailing Address - Country:US
Mailing Address - Phone:570-704-7341
Mailing Address - Fax:
Practice Address - Street 1:2424 BATCHELDER ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-1402
Practice Address - Country:US
Practice Address - Phone:718-743-0220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-11
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY612075163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool